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Utilization Review Rn Jobs in Baton Rouge, LA (NOW HIRING)

UnitedHealth Group

Registered Nurse

Plaquemine, LA

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

UnitedHealth Group

Registered Nurse

Plaquemine, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model You'll be rewarded and ...

UnitedHealth Group

Registered Nurse - RN

Zachary, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse - RN

Baton Rouge, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse - RN

Baton Rouge, LA · On-site

$34.46 - $51.69/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse - RN

Baton Rouge, LA

$34.46 - $51.69/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse - RN

Baton Rouge, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

UnitedHealth Group

Registered Nurse - RN

Zachary, LA · On-site

$41.35 - $62.03/hr

As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to ... Adheres to and participates in the agency's utilization management model * Ability to function in ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Baton Rouge, LA

Utilization Review Rn information

See Baton Rouge, LA salary details

$16

$33

$54

How much do utilization review rn jobs pay per hour?

As of Jun 24, 2026, the average hourly pay for utilization review rn in Baton Rouge, LA is $33.17, according to ZipRecruiter salary data. Most workers in this role earn between $26.20 and $38.08 per hour, depending on experience, location, and employer.

How does a Utilization Review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

How do I become a utilization review RN?

To become a utilization review RN, you typically need to hold a valid registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Utilization Review Certification (URAC) can enhance job prospects, and strong knowledge of medical coding, insurance policies, and healthcare regulations is important.

What are the key skills and qualifications needed to thrive as a Utilization Review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the appropriateness, necessity, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

How to make $300,000 a year as a nurse?

To earn $300,000 annually as a Utilization Review RN, professionals typically need extensive experience, advanced certifications such as CCM or ANCC, and may work in high-paying settings like insurance companies or healthcare consulting firms. Increasing specialization, taking on leadership roles, or working overtime can also boost income, but reaching this level often requires a combination of skills, experience, and strategic career moves.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as CCM or ANCC, and working in high-paying settings like insurance companies or managed care organizations. Advanced skills in case management, strong clinical knowledge, and sometimes working overtime or in leadership roles can also contribute to higher earnings.

What is a Utilization Review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Baton Rouge, LA? The most popular types of Utilization Review Rn jobs in Baton Rouge, LA are:
What are popular job titles related to Utilization Review Rn jobs in Baton Rouge, LA? For Utilization Review Rn jobs in Baton Rouge, LA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Baton Rouge, LA look for? The top searched job categories for Utilization Review Rn jobs in Baton Rouge, LA are:
What cities near Baton Rouge, LA are hiring for Utilization Review Rn jobs? Cities near Baton Rouge, LA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Baton Rouge, LA as of June 2026, with employment types broken down into 88% Full Time, 10% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $68,998 per year, or $33.2 per hour.
Utilization Review Nurse (RN)

Utilization Review Nurse (RN)

Baton Rouge General

Baton Rouge, LA • On-site

Full-time

Posted 8 days ago

Baton Rouge General rating

6.5

Company rating: 6.5 out of 10

Based on 40 frontline employees who took The Breakroom Quiz

685th of 1,002 rated hospitals

Job description

Description
JOB PURPOSE OR MISSION: Responsible for utilization of clinical and financial resources by: ensuring appropriate clinical level of care, performing and submitting clinical information to external payers to secure proper authorization, collaborating with the Care Coordinator in the development and implementation of the plan of care, serving as a primary resource to the Utilization Review Nurse I (LPN), and ensures prompt notification of any denials to the appropriate Care Coordinator, Denials/Appeals Coordinator, and Team Leader. Performs all job duties for the age population served, as defined in the department's scope of service.
PERFORMANCE CRITERIA
CRITERIA A: Everyday Excellence Values - Employee demonstrates Everyday Excellence values in the day-to-day performance of their job.
PERFORMANCE STANDARDS:
  • Demonstrates courtesy and caring to each other, patients and their families, physicians, and the community.
  • Takes initiative in living our Everyday Excellence values and vital signs.
  • Takes initiative in identifying customer needs before the customer asks.
  • Participates in teamwork willingly and with enthusiasm.
  • Demonstrates respect for the dignity and privacy needs of customers through personal action and attention to the environment of care.
  • Keeps customers informed, answers customer questions and anticipates information needs of customers.

CRITERIA B: Corporate Compliance - Employee demonstrates commitment to the Code of Conduct, Conflict of Interest Guidelines, and the GHS Corporate Compliance Guidelines.
PERFORMANCE STANDARDS:
  • Practices diligence in fulfilling the regulatory and legal requirements of the position and department.
  • Maintains accurate and reliable patient/organizational records.
  • Maintains professional relationships with appropriate officials; communicates honesty and completely; behaves in a fair and nondiscriminatory manner in all professional contacts.

CRITERIA C: Personal Achievement - Employee demonstrates initiative in achieving work goals and meeting personal objectives.
PERFORMANCE STANDARDS:
  • Uses accepted procedures and practices to complete assignments. Uses creative and proactive solutions to achieve objectives even when workload and demands are high.
  • Adheres to high moral principles of honesty, loyalty, sincerity, and fairness.
  • Upholds the ethical standards of the organization.
CRITERIA D: Performance Improvement - Employee actively participates in Performance Improvement activities and incorporates quality improvement standards in his/her job performance.
PERFORMANCE STANDARDS:
  • Optimizes talents, skills, and abilities in achieving excellence in meeting and exceeding customer expectations.
  • Initiates or redesigns to continuously improve work processes.
  • Contributes ideas and suggestions to improve approaches to work processes.
  • Willingly participates in organization and/or department quality initiatives.

CRITERIA E: Cost Management - Employee demonstrates effective cost management practices.
PERFORMANCE STANDARDS:
  • Effectively manages time and resources.
  • Makes conscious effort to effectively utilize the resources of the organization - material, human, and financial.
  • Consistently looks for and uses resource saving processes.

CRITERIA F: Patient & Employee Safety - Employee actively participates in and demonstrates effective patient and employee safety practices.
PERFORMANCE STANDARDS:
  • Employee effectively communicates, demonstrates, coordinates and emphasizes patient and employee safety.
  • Employee proactively reports errors, potential errors, injuries or potential injuries.
  • Employee demonstrates departmental specific patient and employee safety standards at all times.
  • Employee demonstrates the use of proper safety techniques, equipment and devices and follows safety policies, procedures and plans.

JOB FUNCTIONS
ESSENTIAL JOB FUNCTIONS include, but are not limited to:
1. Coordinates utilization of clinical and financial resources
PERFORMANCE STANDARDS:
  • Identifies accurate payer information for each assigned patient.
  • Communicates and collaborates with admission/precertification department to ensure appropriate payer precertification is completed for level of care status.
  • Performs admission review on all assigned inpatients and observation patients within one business day of admission for appropriateness of admission and level of care based on medical necessity utilizing InterQual criteria.
  • Refers appropriate cases to physician advisor or designee, communicating via Provider Link and/or telephonically.
  • Communicates with admitting physician as needed to ensure the correct admit level of care status.
  • Performs concurrent review on all assigned patients for appropriateness of level of care and continued stay based on medical necessity utilizing InterQual criteria as required by external payers.
  • Contacts physician and/or Care Coordinator for additional information regarding cases not meeting medical necessity criteria for admission and continued stay reviews.
  • Identifies and refers problem cases to appropriate Care Coordinator and/or supervisor.
  • Maximizes reimbursement to BRGMC by:
    • Communicating pertinent clinical information to payers.
    • Helping to ensure that physician documentation supports current clinical level of care.
    • Communicating and collaborating with Intake Nurse/Care Coordinator to assist with appropriate interventions to avoid denial of payment.
    • Assisting in arranging peer to peer conferences to avoid denial of payment.
    • Assisting in denials/appeals processes.
    • Identifies and communicates to the Care Coordinator opportunities for more efficient resources utilization.
    • Serves as a primary resource to the Utilization Review Nurse I (LPN) by:
      • Assisting with cases that are not meeting medical necessity criteria for admission and continued stay reviews.
      • Communicating with external payers, physicians, and/or Care Coordinator when peer to peer conferences are needed.
      • Ensuring appropriate order is written by the physician, if the level of care is changed.
      • Assisting with cases that have been issued denials and/or rejections.
      • Collaborates with the Care Coordinator in the development and implementation of the plan of care.
      • Documents in Provider Link specific patient information received regarding level of care, authorizations and approved/denied days.
      • Communicates with payers regarding discharges by sending discharge notifications as appropriate.
      • Closes out each case once date of service authorization is complete.
      • Communicates with insurances specialist to ensure all authorizations are timely and complete.

2. Participates in quality improvement activities.
PERFORMANCE STANDARDS:
  • Reports sentinel events and quality of care issues to the Director of Case Management.
  • Collects and tracks data (denials, avoidable days, etc.) as determined by Supervisor and/or Director.
  • Participates in performance improvement activities as needed.

3. Performs all other duties as assigned.
Requirements
EXPERIENCE REQUIREMENTS
Expert knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge
of local and national coverage determinations.
Recent work experience in the hospital or insurance industry.
EDUCATIONAL REQUIREMENTS
Current Louisiana RN licensure
SPECIAL SKILLS, LICENSE AND KNOWLEDGE REQUREMENTS
Demonstrates knowledge of human behavior, socioeconomic factors in disease and illness,
behavior patterns of the physically and mentally ill patient.
Demonstrates outstanding communication skills and can establish constructive relationships with
patients, families, payers, and hospital associates.
Demonstrates advanced knowledge of regulatory and payer requirements as it pertains to level of
care, medical documentation, and medical necessity.
Works well under pressure of time and shifting priorities.
ACM or CCM certification preferred.
HIPAA REQUIREMENTS:
Maintains knowledge of and adherence to all applicable HIPAA regulations appropriate to the job position,
including but not limited to: Medical records without limitation of both paper and electronic, patient
demographics, lab and radiology results, patient information related to surgery or appointment schedules,
information related to patient location, religious beliefs and/or public health records, medical records
related to quality/data, patient financial information and/or 3rd party billing, patient-related complaints,
research information, employee health records and employee prescriptions.
SAFETY REQUIREMENTS:
Maintains knowledge of and adherence to all applicable safety practices appropriate to the job position,
including but not limited to: Incident reporting, PPE, exposure control plans, hand washing, environment
of care, patient identification.

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